Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 8772 | SC |
Y | 1223E0200X | Endodontist | DDS103489 | CA |
N | 1223E0200X | Endodontist | DN015132 | GA |
NPI | 1063728376 |
---|---|
Provider Name | Adam J Lane |
First Address | Columbia, SC 29207-6022 |
Second Address | Columbia, SC 29207-6022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 19/02/2019 |